NCT03796923

Models of Care in the Transition From the Secondary to the Primary Sector Among the Frailest Elderly

Models of Care in the Transition From the Secondary to the Primary Sector Among the Frailest Elderly +75; a Randomized Controlled Trial

• Status: Completed
• Phase: N/A
• Study type: Interventional
• Enrollment: 3,340 (actual)
• Sponsor: University of Aarhus · Academic / Other
• Sex: All
• Age: 75 Years
• Healthy volunteers: Not accepted

Summary

In most Western countries the elderly population increases rapidly. In Denmark, the population of elderly aged 75 years or older may amount to nearly 15 % of the entire population in 2050 compared to 9 % today (2017). A large part of the elderly population is at high risk of hospitalization including more admissions and increased morbidity and mortality. The number of hospital beds is declining persistently, calling for shorter lengths of stay (LOS). Increasingly complex treatments now take place outside hospital. Presently, many Danish regional hospitals establish geriatric wards and other geriatric in-hospital and outpatient services to overcome these challenges. The aim of the present PhD-study is to investigate the effects of different models of transitional care among the frailest elderly patients.

Detailed description

Design Population: The frailest acutely admitted geriatric patients aged +75. Intervention: Early follow-up visits after discharge. Comparison: Usual care follow-up. Outcomes: The primary outcome is readmission within 30 days after discharge. Secondary outcomes are: mortality 30 days after discharge and 90 days after admission, length of stay (LOS), direct discharge from the Emergency Department, time at home before readmission, duration of readmission and physical functional status 30 days after discharge. Methods The first study is conducted as a randomized controlled trial (RCT) using two different degrees of intervention. The second study is a cohort study of an unexposed control group. The third study is sub-group analyses of the RCT data according to frailty status and type of dwelling. A focus group comprised of included patients and relatives will be set to identify additional patient related outcome measures (PROMs) and to participate in an advisory group throughout the remaining project.

Conditions

• Frail Elderly Syndrome
• Transitional Care
• Frailty
• Readmission
• Aging
• Elderly

Interventions

Type	Name	Description
OTHER	Early follow-up visit after discharge	Early follow-up visit and different degrees of specialized care after discharge
OTHER	Comprehensive geriatric assessment (CGA)	Comprehensive geriatric assessment (CGA) during admission
OTHER	Continued geriatric care	Continued specialized geriatric care after discharge
OTHER	Possible follow-up visit from GP	Usual care: follow up visit from GP within one week after discharge

Timeline

• Start date: 2018-01-01
• Primary completion: 2020-09-16
• Completion: 2020-11-16
• First posted: 2019-01-08
• Last updated: 2021-04-30

Locations

1 site across 1 country: Denmark